Key Points:

Most public health services in Auckland and Northland, including emergency departments and cancer care, are under critical or major pressure, a confidential report by district health boards reveals.

The report is a submission by the four northern boards to the Health Ministry's national capital committee on long-term planning for facilities and services. It flags pressure points and suggests that part of the answer may be strengthening community-based care and creating "outreach" clinics for medical oncology in Auckland.

It was obtained by the National Party, whose health spokesman, Tony Ryall, said yesterday that it was "an appalling report card on nine years of neglect".

Labour's David Cunliffe, the Minister of Health, said he had not received nor been briefed on the submission but would be today, after which he would respond more fully.

"The Government is committed to meeting and improving service levels to all New Zealanders.

"Under this Government, over $2 billion has been invested in the largest hospital building programme in living memory."

An earlier submission outlined northern region approval bids totalling more than $281 million to add around 250 hospital beds and emergency department spaces and to build or replace 14 operating theatres.

In the latest submission, which looks collectively at the northern health region's services, only child health is under less than major pressure on all four criteria considered: demand, capacity, clinical and workforce sustainability, and access.

The most consistently stretched services are emergency departments and medicine, because of rising rates of chronic disease, like diabetes, and the ageing population.

The submission also notes the pressures from:

* The shortage of operating theatre capacity and/or support facilities like intensive care beds.

* Growing demand for medical imaging in the face of increasing workforce shortages.

* The shortage of radiation therapists "due to a private facility opening".

* The shortage of cardiothoracic intensive care nurses (which has previously been reported as a key reason for the declining rate of heart bypass and valve surgery in Auckland).

Shortages of these nurses, midwives, medical and radiation cancer specialists, kidney staff and other health workers left a number of services "challenged to deliver appropriate levels of service".

Another critical issue is the shortage of resident medical officers [junior doctors].

Using "best estimates", it was expected to be 10 to 20 years before the Government's improvements to primary care access produced a significant reduction in demand for hospital care.

"Despite a number of national and regional workforce development plans, there has been relatively minimal hard analysis of the projected demand and supply with sensitivity analysis applied."

The Counties Manukau board expects a 52 per cent increase in demand for health workers by 2021, but only a 29 per cent increase in the supply.

Chief executive Geraint Martin said work was being done to close that gap.

He said there was no reason to lose faith in the public health system.